Dealer Application

Business Information

Postal Address*
Shipping Address*
Type of Ownership*

Please indicate names of owners or officers

Owner's/Officer's Information 1

Name*
Home Address*

Owner's/Officer's Information 2

Name
Home Address

Major Supplier #1

Address*

Major Supplier #2

Address*

Major Supplier #3

Address*

Bank Reference #1

Address*
Type*

Bank Reference #2

Address
Type

PLEASE READ AND SIGN THE FOLLOWING STATEMENT AFTER YOU HAVE COMPLETED APPLICABLE SECTIONS

You are authorized to contact parties indicated on this application for verification. For purposes of obtaining credit, I/We certify that the information given in this application is true and accurate, and any financial information submitted correctly reflects our financial condition. I/We agree to pay all invoices within stated terms and to pay services charges on amounts paid after invoice due dates at a rate of 1.5% per month, or the maximum allowable rate, whichever is less. In event suit is instituted to collect amounts owing to you and a judgment is rendered in your favor, I/We agree to pay court costs and reasonable attorney fees. I/We have read this agreement and a copy has been made available to us or is available to us upon our requesting same from the credit department.

Applicant 1

Applicant 2

PERSONAL GUARANTEE – PLEASE DO NOT INCLUDE TITLE WHEN SIGNING PERSONAL GUARANTEE

For value received, including merchandise, services, or other valuable consideration, I hereby unconditionally guarantee at all times, full and prompt payment, upon demand, of any indebtedness which has been incurred under this agreement. I understand this to mean that I will personally guarantee payment of all debts and obligations under this agreement.

Applicant 1

Applicant 2

This field is for validation purposes and should be left unchanged.
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